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Computerized standing orders are more effective than computerized reminders for increasing both influenza and pneumococcal vaccine administration among hospitalized patients, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS07719). The researchers randomized 3,777 general medicine patients discharged from one of six hospital wards during a 14-month period in 1998 and 1999. The study period included two overlapping influenza seasons.
The hospital's computerized physician order entry system identified inpatients eligible for influenza and pneumococcal vaccination. For patients with standing orders, the system automatically produced vaccine orders directed to nurses at the time of patient discharge. No physician signature was required. For patients with reminders, the computer system provided reminders to physicians that included vaccine orders during routine order entry sessions. The doctors still had to
write the orders and have them carried out.
During the 6-month influenza season, 50 percent of all hospitalized patients were identified as eligible for influenza vaccination. During the entire 14-month study period, 22 percent of patients were found eligible for pneumococcal vaccination. Patients with standing orders received an influenza and pneumococcal vaccine significantly more often (42 and 51 percent, respectively) than patients with reminders (30 and 31 percent, respectively).
More details are in "Inpatient computer-based standing orders vs physician reminders to increase influenza and pneumococcal vaccination rates," by Paul R. Dexter, M.D., Susan M. Perkins, Ph.D., Kati S. Maharry, M.A.S., and others, in the November 17, 2004, Journal of the American Medical Association 292(19), pp. 2366-2371.
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